I've got a question about pain control

[Norepinephrine]

I am actually asking this for a friend, but I really would like to know myself because I'm 100% certain this is going to come up one day.

My friend and I are both nursing students, though my friend is a year ahead. My friend is doing her community health clinical, and her patient, among other things, has a broken leg. Trouble is, the leg is horribly swollen (not infected). The patient is already on as many painkillers as they can have, but they're still in quite a bit of pain.

My question is-is there anything at all the nurse could do, asides from medication, to ease the pain of the leg, even a little?

My friend is already going to ask her instructor about it and I'll do my own research as well, but I want to know what you guys would do. I like to hear from as many experienced people as possible, so I can have many things up my sleeve so to speak :-)

Thanks!

EDIT: I misunderstood. Derp! My excuse is that I'm pretty sick and very sleep deprived from beings sick. The Lovenox shot is not in the leg, but they are quite uncomfortable for the patient anyway. That's what was said to me, and in my haze I misunderstood. I am a huge idiot when I'm very sleep deprived (haven't slept more than 3 hours in over a week now, plus I'm sick) and that's why I would never go to work in this condition (which doesn't happen often at all-I haven't been this sick since I was a kid).

[CelticGoddess, BSN, RN]

Question: why lovenox in the leg?

[Norepinephrine]

Not sure. I thought that was unusual as well. It's possible my friend misspoke or I misunderstood.

[macawake, MSN]

My friend is doing her community health clinical, and her patient, among other things, has a broken leg. The patient has to have Lovenox shots in the leg.

Why does the patient have to have the Enoxaparin injected into the affected leg of all places?

The patient is already on as many painkillers as they can have, but they're still in quite a bit of pain.

I don't work ortho, but making sure that patient's pain is adequately treated is something I do daily at work (pacu and anesthesia). Your friend or the patient's nurse need to address the fact that the patient is still in significant pain, with the patient's physician/medical provider. "As many painkillers as they can have" isn't a concept I understand. Orders can be changed and other interventions implemented as needed.

I can't offer specific advice, I think that your friend needs to take this up with her/his preceptor or clinical instructor (whomever is the appropriate person).

Good luck!

[Pepper The Cat, BSN, RN]

Lovenex is usually given in the stomach.

[Norepinephrine]

You're all right! Sorry, I got that bit wrong. I edited the original post.

[Here.I.Stand, BSN, RN]

I agree with macawke--this should be addressed with the client's provider. Drugs like acetaminophen have an upper limit (usually 4 gm/24 hrs); opiates do not. So for example, even if s/he is maxed out on Percocet, they can add plain oxy to be taken in between Percocet doses.

[CT Pixie, BSN, RN]

My question is-is there anything at all the nurse could do, asides from medication, to ease the pain of the leg, even a little?

My friend is already going to ask her instructor about it and I'll do my own research as well, but I want to know what you guys would do. I like to hear from as many experienced people as possible, so I can have many things up my sleeve so to speak :-)

I work in ortho and this comes up frequently. You had asked aside from pain medications if there is anything the nurse can do to help alleviate the pain even if just a little.

First off, ortho pain (broken bones, ortho surgery etc) is very painful. That being said, our ortho docs usually give order for a variety of pain meds that can be given alone or in conjunction with the other meds ordered. If the patient is still in a lot of pain,and the medications and non-medication interventions aren't helping or only helping slightly, the doctors should be alerted to the uncontrolled pain the patient is stating. Our docs are pretty good at revisiting the pain med orders and coming up with meds and/or combinations of meds that do control the pain.

Now, for non-medication interventions...often just moving the affected extremity helps quite a lot. The simple act of positioning the extremity will often lesson the pain thereby stopping the need for any futher pain medications. Also, elevating the extremity can help. Ice packs to the affected part often helps. As long as its not a hard cast, the ice can and does make its way through the bandaging. Repositioning the patient (as a whole) can often help.

I had a patient just the other day who was having severe cramping in the arm and pain in the arm all it took was just repositioning the arm to alleviate her pain and cramping.

Sometimes, no non-medication interventions and/or medications can help and thats when the doctor really needs to reevaluate the medication regime.

[sjalv]

If the broken leg has a cast on it, which I'm gonna guess it does, and the patient is experiencing pain that is unrelieved with opioids, your friend should also be sure to be assessing the circulatory status of the extremity. Are pulses present, is the skin cool or warm to touch, etc. Compartment syndrome is always a concern when a patient has a cast, and pain unrelieved by medication is a symptom.